Outcomes Identification of postoperative care amenable to telehealth Kristy Kummerow Broman, MD, MPH, a,b,c Michael A. Vella, MD, a,c John L. Tarpley, MD, FACS, FWACS, a,c Robert S. Dittus, MD, MPH, b,d and Christianne L. Roumie, MD, MPH, b,d Nashville, TN Background. Postoperative follow-up using telehealth may increase patient access and decrease resource use. We aimed to define patient and operative criteria likely to be associated with successful telehealth follow-up (telehealth-amenable). Methods. We assembled a retrospective cohort of veterans who underwent general operations between September 2012 and July 2013 to characterize telehealth-amenable postoperative follow-up, excluding patients with sensitive operative sites (breast, anus) and postoperative inpatient complications. Telehealth-amenable follow-up was defined as: postoperative care accomplished in a single clinic visit without an invasive procedure or focal concern and no new complication diagnosed or managed. Operations were categorized by site and complexity. Patient and operative characteristics predictive of telehealth-amenable follow-up were delineated using multivariable logistic regression. Results. Eligible patients (251/300) were 94% men, on average 60 years old (±12.0 years) and attended a median of one postoperative visit (interquartile range [IQR] 1–2). Forty-seven percent (119/ 251) had telehealth-amenable follow-up, including 70% of simple abdominal operations, 75% of neck operations, and 38% of skin/soft tissue operations. After adjustment, predictors of telehealth-amenable follow-up included simple abdominal (odds ratio 3.37, 95% confidence interval 1.20–9.51) and neck operations (odds ratio 4.56, 95% confidence interval 1.01–20.54). Patients with postoperative durations of stay of $4 days were less likely telehealth-amenable (odds ratio 0.15, 95% confidence interval 0.04–0.50). Most patients who initiated contact with the operative team between discharge and follow-up did not have telehealth-amenable follow-up (43/53, 81%). Conclusion. Telehealth postoperative follow-up may be feasible for patients undergoing select abdominal, neck, and skin/soft tissue operations with uncomplicated courses, operative duration of stay <4 days, and no interval contact with the operative team. (Surgery 2016;160:264-71.) From the Department of Surgery a and the Geriatric Research, Education, and Clinical Center, b Tennessee Valley Healthcare System Veterans Affairs Medical Center; and the Departments of Surgery c and Medicine, d Vanderbilt University Medical Center, Nashville, TN INTEREST IS EMERGING IN USING TELEHEALTH to increase access to care and improve efficiency of health care delivery. 1 Telehealth has been used to provide operative subspecialty consultation to rural pa- tients and is routinely used by integrated health systems, including the Veterans Health Administra- tion, to reach geographically dispersed patient populations. 2-4 Prior work has demonstrated that some postoperative patients can also be effectively managed using video, static image-based, or telephone-based care, but studies have been limited to small pilot or simulation studies with narrowly defined operative types and patient popu- lations. 5-12 Guidance is lacking on which patients and operations can be appropriately managed us- ing telehealth. We intended to implement telehealth for postoperative follow-up after general operations at a Veterans Affairs hospital using either video, telephone, or electronic messaging with static image sharing. As part of our quality improve- ment planning process, we sought input from Supported by the Office of Academic Affiliations (OAA), Department of Veterans Affairs, VA National Quality Scholars Program, and with use of facilities at VA Tennessee Valley Healthcare System, Nashville, TN. Accepted for publication February 13, 2016. Reprint requests: Kristy Kummerow Broman, MD, MPH, Ten- nessee Valley Healthcare System Veterans Affairs Medical Cen- ter, Nashville, TN 37232. E-mail: kristy.kummerow@va.gov . 0039-6060/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.surg.2016.02.015 264 SURGERY